Group Health Insurance

Question 2

In general, the premium cost for group health insurance may be based on _____ or _____ rating

Answer 2

Experience; community

Question 3

Experience rating

Answer 3

A method of establishing the premium on the group’s previous claims experience. The larger and more homogenous the group, the closer it comes to reflecting standard mortality and morbidity rates

Question 4

Community rating

Answer 4

Sets premium costs by using the same rate structure for all subscribers to a medical expense plan, no matter what their past loss experience has been

Question 5

Eligible group health coverage groups:

Answer 5

-employer sponsored
-multiple employers combined (multiple employer trust (MTE), Multiple employer welfare arrangement (MEWA))
-labor unions
-trade or professional association
-lender group

Question 6

Group underwriting means that individuals can enroll in a group health insurance plan without:

Answer 6

Providing evidence of insurability

Question 7

Larger groups are more likely to avoid _____ _____

Answer 7

Adverse selection

Question 8

Employees pay part of the cost of coverage in _______ plans

Answer 8

Contributory

Question 9

During a 1-6mo ______ _____, new employees must wait before they can enroll in an employer’s group health insurance plan

Answer 9

Probationary period

Question 10

After the probationary period ends, new employees can enroll in the group health insurance plan during the _____ or ______ period, typically 30 or 31 days

Answer 10

Eligibility; enrollment

Question 11

Most states require insurers to offer an ____ ______ period every year

Answer 11

Open enrollment

Question 12

Determines which health plan will be used as the primary plan if a married couple has children

Answer 12

The parent whose birthday comes earliest in during the year will use their plan as the primary

Question 13

A group health insurance policy is regaled by the ______ in which it is delivered

Answer 13

State

Question 14

Many states have __ ____, ___ _____ statutes that require benefits for ongoing (disability) claims that started under an old plan to continue without imposing the new plan’s eligibility requirements

Answer 14

No loss; no gain

Question 15

COBRA is a federal law that requires

Answer 15

Employers with 20 or more employees to allow former employees and their dependents to continue the benefits provided by the employer’s group health insurance plan. May be continued for 18 or 36 months. Employees or dependents remain on the group plan but must pay the entire premium for the coverage

Question 16

Employers must provide notification statements to individuals eligible for COBRA continuation within __ days

Answer 16

14

Question 17

The option to elect continuation under COBRA expires ___ days after an individual receives the notification

Answer 17

60

Question 18

The maximum period of coverage continuation for termination of employment or reduction in hours of employment is __ months

Answer 18

18

Question 19

OBRA extended the minimum COBRA continuation of coverage period to ___ months for qualified beneficiaries disabled at the time of termination

Answer 19

29